Nurse Case Manager II

Elevance Health • Louisville, KY

2d • Remote

About The Position

The Nurse Case Manager II provides care management within the scope of licensure for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans to optimize member health care across the care continuum. Duties are performed telephonically. The position is primarily virtual, with required in-person training sessions, and requires the associate to reside in Kentucky. Work hours are Monday through Friday, 11:30 a.m. to 8 p.m.

Requirements

• Bachelor's degree in a health-related field and at least 5 years of clinical experience, or an equivalent combination of education and experience.
• Current, unrestricted RN license in Kentucky.
• Multi-state licensure is required if providing services in multiple states.

Nice To Haves

• Certification as a Case Manager.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and create care management plans addressing assessment objectives and goals.
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care management plan effectiveness and modify plans as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assist with problem-solving provider, claims, or service issues.
• Assist with the development of utilization and care management policies and procedures.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• Short- and long-term disability benefits
• 401(k) with match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level